Individual
JADE A GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
700 HYUNDAI BLVD, MONTGOMERY, AL 36105-9622
(334) 387-8421
Mailing address
109 CAMELLIA DR, PRATTVILLE, AL 36067-2603
(334) 399-2211
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2152
AL
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/05/2018
Last updated
11/16/2021
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